Provider Demographics
NPI:1639398530
Name:CAMPBELL, MELODY RUTH (CNS)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:RUTH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MRS
Other - First Name:MELODY
Other - Middle Name:CAMPBELL
Other - Last Name:GOETTEMOELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3535 SOUTHERN BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1221
Mailing Address - Country:US
Mailing Address - Phone:937-395-8556
Mailing Address - Fax:937-395-6376
Practice Address - Street 1:3535 SOUTHERN BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-395-6376
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03932364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH510550Medicare PIN